Tiffany Floyd
Greater Montgomery,AL
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Sure to provide great attention to detail and effective communication. Also, 5 + years claim correspondence, and medical coding. Highly familiar with claims processing, prescription and medical authorizations, denials and referrals as it relates to patient service revenue. Offer great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
14
14
years of professional experience
Work History
Medical Referral Specialist
Elevance Health
04.2023 - Current
- Obtain approximately 80+ prior authorization daily for radiology and surgical procedures accurately and efficiently.
- Administer high-quality service standards for all clinical referrals, prior authorization initiation, denial claims, retrospective and case status via data entry.
- Deliver and maintained composer under high-pressure situations with enhanced communication skills, active listening, empathy, and clear verbal responses during customer interactions, difficult calls or high-volume periods.
- Skills: Prior Authorization, Current Procedural Terminology (CPT), U.S
- Health Insurance Portability and Accountability Act (HIPAA), QuickBooks, Referrals, Medical Terminology, Avaya IP Telephony, Teams, Workday, Support Services, Call center.
Administrative Assistant
MRT Enterprise
05.2022 - 04.2023
- Created and managed approximately 300+ invoices for potential loads through QuickBooks all while making sure past loads have been paid by identifying correct remittance, bill of lading and rate confirmation.
- Balanced weekly and monthly gas and invoice ledgers, physical and digital folders, and profiles along with all filing to maintain organization for auditing purposes.
- Assisted with dispatching and weekly payroll
- Skills: Hospitality, U.S
- Health Insurance Portability and Accountability Act (HIPAA), QuickBooks, Medical Terminology, Google Docs
Insurance Authorization Specialist
Ensemble Health Partners
04.2021 - 05.2022
- Liaison between 500 + patients, ordering physician and insurance company to ensure all requirements are met while using, IDX, Cerner, Ecare, OneSource and EPIC for secure authorized approvals through insurance payer sites, such as Optima, Humana Miliary-Tricare, Healthhelp, RadMD, Availity, UHC, Evicore and BCBS along with supported documentation in timely manner.
- Verified patient eligibility, EOB, ICD codes and CPT codes to obtain estimates and inform patient of amount due.
- Managed high-volume caseloads to meet strict submission deadlines, prioritizing tasks accordingly.
Prior Authorization Specialist/ Referral Clerk
Community Medical Arts Center
02.2020 - 04.2021
- Efficiently processed 300+ incoming referrals, precertification, and prior authorization requests by contacting health plans verbally or electronically via medical insurance companies, Cover My Meds or Sure Scripts for patient prescriptions and or scheduled surgical procedures and tests, including MRIs, CTs, and Sleep Studies within medical guidelines
- Applied billing and coding principles consistent with government regulatory standards and facilitated reimbursement and claims processing.
- Collaborated on outstanding authorizations with physicians, patients, insurance companies, and pharmacies regarding status of denial, peer-to-peer, review, and/or additional information to obtain necessary clinical information for prior authorization submissions.
Medical Receptionist
Community Medical Arts Center
08.2017 - 02.2020
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Answered incoming calls on high-volume, multi-line phone switchboard and coordinated calls appropriately.
- Optimized patients’ satisfaction, provider time, and treatment room utilization by scheduling appointments in person or by telephone.
- Collected all personal, medical, and insurance information from 600+ patients to provide accurate verification of benefits.
- Also assisted with outstanding collections, scheduling, rescheduling, cancelling, and confirming appointments via phone or campus as well as, periodic training as follow-up biller for reimbursements.
- Utilized Greenway software to manage patient records and files, ensuring patient confidentiality as required by HIPAA and clinic guidelines.
Customer Sales Representative
Money Now
02.2017 - 08.2017
- Assisted 200+ customers with loans and consistently provided excellent customer service.
- Educated customers on promotional options, sales policies and methods for obtaining desired results from company offerings.
- Managed office when manager was absent, including compliance record keeping, payments, file organization, marketing, promotion to lower delinquency and completion of all opening and closing procedures.
Customer Sales Representative
Advance America
03.2015 - 04.2016
- Completed 500+ transactions on all account holders in timely manner while performing daily customer transactions with 90% accuracy.
- Maintained cash controls and assisted with collecting over 2,000 pasts due, NSF, and write-offs.
Sales Associate
Factory Connection
07.2010 - 03.2015
- Greeted and assisted approximately 500+ customers daily, providing information on products and overlooked deals/discounts.
- Operated cash register after sale while remaining focused on selling products and excellent customer service.
- Organized racks and shelves to maintain store visual appeal guaranteeing repeat business and customer satisfaction.
Education
Court Reporting -
Prince Institute
Montgomery, ALCertified Billing and Coding Specialist -
JES Health Services
Montgomery, AL04.2019
Associates of Science in Business Management -
Columbia Southern University
Orange Beach, AL07.2018
Skills
- EPIC
- Greenway
- IDX
- Cerner
- OneSource
- Ecare
- Nthrive
- Microsoft Word
- Quickbooks
- Numbers and Teams
Knowledge Skills Areas
- Prior Authorization
- Referrals
- ICD 10
- Customer service
- Insurance verification
- Claims
- Data Entry
Timeline
Medical Referral Specialist
Elevance Health
04.2023 - Current
Administrative Assistant
MRT Enterprise
05.2022 - 04.2023
Insurance Authorization Specialist
Ensemble Health Partners
04.2021 - 05.2022
Prior Authorization Specialist/ Referral Clerk
Community Medical Arts Center
02.2020 - 04.2021
Medical Receptionist
Community Medical Arts Center
08.2017 - 02.2020
Customer Sales Representative
Money Now
02.2017 - 08.2017
Customer Sales Representative
Advance America
03.2015 - 04.2016
Sales Associate
Factory Connection
07.2010 - 03.2015
Court Reporting -
Prince Institute
Certified Billing and Coding Specialist -
JES Health Services
Associates of Science in Business Management -
Columbia Southern University
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